I hereby certify to the Board of the Northern Baptist Education Society that I have made a correct answer to each inquiry of this report, have conformed to the rules of the Society, and thatit continues to my unwavering purpose to devote my life to the work of the gospel ministry through the American Baptist Churches USA, and that I need and hereby solicit aid from the Society. I further agree to repay the grants made if I do not serve an American Baptist related ministry for a minimum of five (5) years.

I give permission for the Financial Aid officer of my seminary to release information about me to the official representatives of the Northern Baptist Education Society.

(Signature of Applicant)

(Date)

I hereby certify that the student whose returns are annexed is a student at this institution.

Ialso certify that he/she, to the best of my knowledge, is sustaining a good moral and Christian character, is making the required proficiency in his/her studies, and in my judgment is worthy of the aid from the Northern Baptist Education Society.